Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by signs and symptoms of heart failure in the presence of a normal left ventricular ejection fraction. Although it accounts for up to 50% of all clinical presentations of heart failure, there are no evidence-based therapies for HFpEF to reduce morbidity and mortality. Additionally there is a lack of mechanistic understanding about the pathogenesis of HFpEF. HFpEF is associated with many comorbidities (such as obesity, hypertension, type 2 diabetes, atrial fibrillation, etc.) and is coupled with both cardiac and extra-cardiac abnormalities. Large outcome trials and registries reveal that being obese is a major risk factor for HFpEF. There is increasing focus on investigating the link between obesity and HFpEF, and the role that the adipose tissue and the heart, and the circulating milieu play in development and pathogenesis of HFpEF. This review discusses features of the obese-HFpEF phenotype and highlights proposed mechanisms implicated in the inter-tissue communication between adipose tissue and the heart in obesity-associated HFpEF.
Highlights
Reviewed by: Petra Kienesberger, Dalhousie University, Canada Salvatore Carbone, Virginia Commonwealth University, United States Sergio Martinez Hervas, University of Valencia, Spain
It accounts for up to 50% of all clinical presentations of heart failure, there are no evidence-based therapies for Heart failure with preserved ejection fraction (HFpEF) to reduce morbidity and mortality
HFpEF is associated with many comorbidities and is coupled with both cardiac and extra-cardiac abnormalities
Summary
Decreased exercise tolerance is an early symptom of HFpEF and is a major determinant of prognosis and associates with a reduction in quality of life [83]. The pattern of regional adipose deposition, with increased intra-abdominal and intermuscular fat appear to associate with decreased peak VO2, and may be related to adverse consequences in exercise tolerance in HFpEF beyond total body adiposity [87]. A recent study demonstrated that exercise training improved exercise capacity and body composition, with a reduction in total fat mass and thigh muscle/inter-muscular fat ratio, and with reduced inflammation and LV mass [92]. Preclinical studies in obese HFpEF rats showed that exercise training improved exercise capacity [36]. Further studies are warranted in order to investigate specific mechanisms involved
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